Provider Demographics
NPI:1346558400
Name:CONSULTANTS IN PAIN MEDICINE, LLC
Entity Type:Organization
Organization Name:CONSULTANTS IN PAIN MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-466-9111
Mailing Address - Street 1:3221 GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4851
Mailing Address - Country:US
Mailing Address - Phone:912-466-9111
Mailing Address - Fax:912-466-0366
Practice Address - Street 1:2452 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-6336
Practice Address - Country:US
Practice Address - Phone:912-283-6877
Practice Address - Fax:912-283-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6400190002OtherDME PTAN
GA6400190002OtherDME PTAN